Cannabis Use Disorder (CUD)

Conduct disorder-related hospitalization and substance use disorders in American teens

In summary

Cannabis use was found to highly correlate with inpatients diagnosed with conduct disorder amongst teenagers. Although some cannabis use was self-reported by patients dealing with other psychiatric disorders, it was seen most significantly in those with conduct disorder (CD), suggesting a higher risk of comorbidity between CD and substance use disorders. Although cannabis use was the most common substance reported by patients it was closely followed by tobacco and alcohol use. The demographics of patients using cannabis varied although those suffering from CD and substance use disorder were primarily male and black. Further research should be conducted to develop efficient prevention strategies.

Looking into the substance use frequency and patterns of stigmatized or marginalized groups is not often done leaving many populations without specialized treatment or prevention programs. If members of the male black population are at a higher risk of developing substance use disorders then our prevention efforts should address that population first and foremost. People begin using substances for different reasons although some motivations are common among certain populations. By examining the underlying motivation for substance use frequency members of the healthcare community may be able to develop custom prevention or treatment methods by utilizing psychology or another science to drastically decrease the frequency of substance use disorders in all populations.

In a recent study published by the American Psychological Association researchers determined that addictive disorders, like cannabis use disorder, are associated with neuroticism, low agreeableness, and low conscientiousness. Neuroticism, agreeableness, and conscientiousness are some of the Big Five personality traits, which was the taxonomy chosen by the researchers to examine possible personality underpinnings of addictive behavior and comorbidity. As all three of the traits were equally associated with substance use disorders they may explain the co-occurrence of addictive behaviors but these traits also may more broadly associate the propensity to develop any psychiatric disorder. Further research is needed to fully elucidate the relationship between neuroticism, agreeableness, and conscientiousness for substance use disorders as the research may lead to the development of better prevention programs.

The idea of cannabis use disorder is interesting as the endocannabinoid system does not act upon the reward system, making the threat of addiction almost nil. Cannabis is often pedestilized by advocates for its safety profile, especially when compared to other pain medications like opioids, yet there are still some concerns for dependency. The endocannabinoid system is ever changing, especially as we learn more about it. Very little research has been done that assesses cannabis dependency although it is known that, like with most substances, frequent users gain a tolerance to cannabis. Tolerance to cannabis can be reset with abstinence, supposedly for a 48 hour period, but again more research is needed. Tolerance, addiction, and dependence all need to be properly defined and standardized across the medical community, not just the advocates, because addiction and dependence can be frightening words that should not be thrown about.

The study is available for review or download here: https://drive.google.com/file/d/1xQqAEU3sr5niKtarRR_nUutUwDE6E4um/view?usp=sharing

Reduction in Cannabis Use and Functional Status in Physical Health, Mental Health, and Cognition

In a survey of 111 cannabis use disorder (CUD) patients with abstinent, low use, or heavy use of cannabis, similar benefits were experienced by patients who reduced their use to zero or low use. Both groups exhibited significantly better outcomes than the heavy use group with respect to overall health, appetite, and depression. According to the study, CUD patients “who used cannabis at a low level did not differ from the abstinent individuals in any of the functional outcome measures.” With a relatively small subject population, it is challenging to know if this is applicable to broader audiences, but regardless, It is likely to open up some new treatment option for CUD patients.

Comparing dopaminergic dynamics in the dorsolateral striatum between adolescent and adult rats- Effect of an acute dose of WIN55212-2

Brief summary:

A recent study has exposed an age-dependent mechanism within the dopaminergic system that relies on cannabinoid receptor 1 (CB1). Adult and adolescent dopamine levels were examined in the presence of a CB1 agonist and increased levels of extracellular dopamine were found in adolescents. This study reveals the different effects cannabis-based medicine has depended on the age of the patient and warrants future research to ensure cannabis has the desired therapeutic effect on patients.

Dr Caplan Discussion Points:

This adds a helpful layer of insight to the way an animal model of dopamine changes over time, as well as its interaction with exogenous cannabinoids. This sheds light on the natural evolution of the dopamine control system (irrespective of how it interacts with endocannabinoids), and it also points to how cannabinoids may be involved.

This helps to educate the discussion about how psychosis and cannabis use may interact. There is a long-held understanding that dopamine abnormalities in the specific parts of the brain (mesolimbic and prefrontal brain regions) exist in schizophrenia. More recently, research has also strongly suggested that other neurotransmitters, including glutamate, GABA, acetylcholine, and serotonin are also involved in schizophrenia (and, coincidentally, there is also interaction with these other neurotransmitters from various components of cannabis). Nonetheless, this study simply suggests that, by nature, basal dopamine levels increase during adolescence. Also, the study points out that some cannabinoids boost basal levels too. It seems logical to suggest that excessive dopamine may create a problematic force of additional tipping toward illness, within individuals for whom a congenital predisposition toward illness exists.

Title: Adolescent Cannabis Use and Risk of Mental Health Problems – The Need for Newer Data

Here, an article presenting a case, justifying the need for new research to determine how cannabis use in adolescents may affect their risk for mental health. Few recent studies have come out discussing mental health and adolescent use. This is problematic because, over the years, cannabis products have been curated to be significantly more potent than in the past. Considering how vulnerable the brain is, during adolescence, because it is still developing, longitudinal studies need to be conducted to fully elucidate the effects of cannabis on development.

This review highlights how poorly adolescents consuming cannabis seem to be at titrating their dose, or correctly self-regulating consumption of cannabis. There is an overall need for greater education before cannabis is acquired, from a dispensary or otherwise. For adults and teens seeking to self-regulate their use of cannabis, irrespective of the consumption method, it is difficult to succeed, considering the gross lack of knowledge and sophistication around the dosage. The wide variabilityin choice and make-up of cannabis products, added to the complexity associated with how each patient may process the myriad of cannabinoids within the products consumed leads to a complexity of confounding variables, and here, a call for more studies to be conducted on more than just adolescents.

Cannabidiol (CBD) as an Adjunctive Therapy in Schizophrenia: A Multicenter Randomized Controlled Trial

Most schizophrenia medications function by blocking the action of the dopamine D2 receptor and effectively treat positive psychotic symptoms, such as delusions or hallucinations, but fail to treat negative psychotic symptoms, such as lack of motivation or the lack of an ability to feel pleasure. Anecdotal evidence has pointed toward the potential for CBD to attenuate psychotic symptoms in conjunction with normally prescribed antipsychotics; additionally, CBD is not hypothesized to act on the D2 receptor, suggesting that it may afford unique advantages over anti-psychotics.

Researchers interested in further exploring this conducted the first known placebo-controlled CBD trial among schizophrenia patients. Although results did not suggest a potential for CBD to treat negative psychotic symptoms, in conjunction with antipsychotics, the CBD group experienced marked lower levels of positive psychotic symptoms. Both the placebo and CBD groups experienced equal levels of treatment-induced adverse events, suggesting that CBD is well-tolerated.

These results suggest that CBD may be effective in treating not only schizophrenia but also psychotic symptoms associated with Parkinson’s disease and THC-induced psychosis.

Additional Point: CBD has shown to act in a neuroprotective manner and reduce the psychoactive effects of THC, making it a viable option for patients who have experienced negative side effects with THC.

A new literature review summarizing the recent findings relating to cannabis and anxiety.

Researchers conclude that CBD and low-dose THC can cause relaxation and decrease anxiety and self-spun thoughts. Some studies show that high-dose THC can cause psychotic symptoms; however, studies also show that CBD can protect against those THC-induced symptoms. Therefore, using cannabis extracts with THC and CBD could be a safe way to reduce anxiety.

Cannabis sativa, specifically Nigerian hemp, has been found to have adverse effects on male fertility. It’s use has been linked to a decrease in semen parameters, germ cell proliferation, and reproductive organ weight. It can induce hyperprolactinemia, a condition causing infertility in 11% of men with low sperm count.

Data from the National Drug Law Enforcement Agency in Nigeria has suggested users preferentially obtaining hemp from the Benin Republic. In a recent study investigating the composition of Benin republic hemp, a lack of THC and lower levels of cannabinol were observed. Additionally, an ethanol extract of Benin republic hemp increased sperm count, morphology, and viability.

Additional Point: Certain phytocannabinoids found in cannabis have demonstrated a detrimental effect on male fertility. However, analysis of hemp from the Benin republic shows a low to no levels of these toxic cannabinoids and evidence points to this particular hemp enhancing male fertility.

Roughly 9% of cannabis users become dependent. In a recent study, scientists identified a significant association between CHRNA2 gene expression and a diagnosis of Cannabis Use Disorder. In other words, genetics might help to explain why some people may find themselves more dependent upon cannabis than others.

Some people are concerned that Cannabinoid Hyperemesis Syndrome (CHS,) a rare condition involving cyclical vomiting, may be caused by neem oil or pesticides. However, symptoms are more consistent with an overload of CB1 receptors, circumstances that occur primarily with habitual, large-volume consumers. Here, an interesting review of the ongoing public conversation: http://bit.ly/2LepwAV